The Middle Way Meditation Retreat

THE MIDDLE WAY ONLINE APPLICATION FORM

Step 1 - Personal Information » Step 2 - Credit card information » Step 3 - Finish

Fields marked with are required.

Course :

1. Personal information

Title :

Name :

Lastname :

Gender :

Male Female

Nationality :

Country of birth :

Living country :

Native language :

Second language :

Date of birth :

/ /

Age :

Occupation :

Passport no. :

Expiry date :

/ /

How is your health? :

Strong Weak Passable

Give Detail of Illness and/or dietary requirement:

2. Contact information

Present address :

City :

State / Province :

Zip Code :

Country :

E-mail Address :

Cell Phone :

Home Phone :

Work Phone:

Fax :

3. Meditation Experience

3.1 Have you ever meditated before? Yes No

If yes, since

How often?

3.2 What is the technique of meditation you use regularly?

What is your best meditation experience?

3.3 Have you ever practiced Dhammakaya Meditation technique?

Yes No

If yes, since

How often?

What is your best meditation experience according to Dhammakaya Meditation Technique?

4. Why and How You Join the Retreat?

4.1 What is your main goal of joining the retreat?

4.2 Who or what inspired you to apply for this retreat?

	Friend	name
	Family	name
	Visiting Wat Phra Dhammakaya (Thailand)	when (last time)
	Dhammakaya Branch center	which center
	Poster	where
	Brochure	where
	DMC (Dhamma Media Channel)
	TV Channel	channel
	Radio Channel	channel
	Internet	website
		keywords

Payment

- Please select the course -

I have read and fully understood the Guideline for Joining the Retreat, and I am willing to observe the code of conduct and other requirements expressed therein for the peace and harmony of the meditation community.